PREVELANCE OF BIOETHICAL ISSUES
Autonomy
 From the Greek word autos meaning self and the word
nomos meaning rule, governance, or law.
 With autonomy, patients have the choice and freedom to
seek other opinions to validate what the physician advised
them to do.
 Patients have the right to decline or ask for alternative
medical treatment
Patient Bill of Rights
1. Right to appropriate medical care and human treatment
2. Right to informed consent
3. Right to privacy and confidentiality
4. Right to information
5. Right to choose health care provider and facility
6. Right to self-determination
7. Right to religious belief
8. Right to medical records
9. Right to leave
10. Right to refuse participation in medical research
11. Right to correspondence to receive visitors
12. Right to express grievances
13. Right to be informed of his rights and obligation as a patient
Right to Appropriate Medical Care and Human Treatment
 Every person has a right to health and medical care
corresponding to his state of health, without any
discrimination and within the limits of the resources,
manpower, and competence available for health and medical
care at the relevant time
 If any person cannot immediately be given treatment that is
medically necessarily he or she shall, depending on his or
her state of health, either be directed to wait for care, or be
referred or sent for treatment elsewhere, where the
appropriate care can be provided.
Right to Informed Consent
 The patient has a right to a clear, truthful, and substantial
explanation, in a manner and language understandable to
the patient, of all proposed procedures, whether diagnostic,
preventive, curative, rehabilitative, or therapeutic, wherein
the person who will perform the said procedure shall provide
his name and credentials to the patient, possibilities of any
risk of mortality or serious side effects, problems related to
recuperation, and probability of success and reasonable
risks involves.
 The patient will not be subjected to any procedure without
his written informed consent, except in the following cases:
- In emergency cases, when the patient is at imminent risk of
physical injury, decline of death if treatment is withheld or
postponed. In such cases, the physician can perform any
diagnostic or treatment procedure as good practice of
medicine dictates without such consent;
- when the health of the population is dependent on the
adoption of a mass health program to control epidemic;
- when the law makes it compulsory for everyone to submit a
procedure;
- When the patient is either a minor, or legally incompetent, in
which case. a third party consent Is required;
- when disclosure of material information to patient will
jeopardize the success of treatment, in which case, third
party disclosure and consent shall be in order;
- When the patient waives his right in writing.
Right to Privacy and Confidentiality
 The privacy of the patients must be assured at all stages of
his treatment.
 The patient has the right to be free from unwarranted public
exposure, except in the following cases:
- When his mental or physical condition is in controversy and
the appropriate court, in its discretion, order him to submit to
a physical or mental examination by a physician;
- When the public health and safety so demand; and
- When the patient waives this right in writing.
 The patient has the right to demand that all information,
communication and records pertaining to his care be treated
as confidential.
 Any health care provider or practitioner involved in the
treatment of a patient and all those who have legitimate
access to the patient's record is not authorized to divulge
any information to a third party who has no concern with
the care and welfare of the patient without his consent,
 except:
- when such disclosure will benefit public health and safety
- when it is in the interest of justice and upon the order of a
competent court;
- when the patients waives in writing the confidential nature
of such information;
- when it is needed for continued medical treatment or
advancement of medical science subject to de-identification
of patient and shared medical confidentiality for those who
have access to the information.
Right to Information
 In the course of his/her treatment and hospital care, the
patient or his/her legal guardian has a right to be informed:
- of the result of the evaluation of the nature and extent of
his/her disease
- any other additional or further contemplated medical
treatment on surgical procedure or procedures, including any
other additional medicines to be administered and their
generic counterpart
- possible complications and other pertinent facts, statistics or
studies, regarding his/her illness
 any change in the plan of care before the change is
made
 person's participation in the plan of care and necessary
changes before its implementation
 the extent to which payment maybe expected from
Philhealth or any payor and any charges for which the
patient may be liable
 The disciplines of health care practitioners who will render
the care and the frequency of services that are proposed to
be furnished.
 The patient or his legal guardian has the right to examine
and be given an itemized bill of the hospital and medical
services rendered in the facility
 The patient or his or her legal guardian has the right to be
informed by the physician or his/her delegate of his or her
continuing health care requirements following discharge
Right to Choose Health care provider and facility
 The patient is free to choose the health care provider to
serve him as well as the facility except when he is under the
care of a service facility or when public health and safety so
demands or when the patient expressly waives this right in
writing.
 The patient has the right to discuss his condition with a
consultant specialist, at the patient's request and expense.
He also has the right to seek for a second opinion and
subsequent opinions, if appropriate, from another health
care provider/practitioner.
Right to Self-determination
 The patient has the right to avail himself/herself of any
recommended diagnostic and treatment procedures. Any
person of legal age and of sound mind may make an
 PREVELANCE OF BIOETHICAL ISSUES
advance written directive for physicians to administer
terminal care when he/she suffers from the terminal phase of
a terminal illness: provided That
- he is informed of the medical consequences of his choice;
- he releases those involved in his care from any obligation
relative to the consequences of his decision;
- His decision will not prejudice public health and safety.
Right to Religious belief
 The patient has the right to receive spiritual and moral
comfort, including the help of priest or minister of his or her
chosen religion
 He or she also has the right to refuse medical treatment or
procedures which may be contrary to his religious beliefs,
subject to the limitations:
- The patient is of legal age and is mentally competent
- The patient is informed of the medical consequences of his
or her refusal
- The patient releases those involved in his care from any
obligation relative to the consequences of his or her decision
- The patient’s refusal will not jeopardize public health and
safety
Right to medical records
 The patient is entitled to a summary of his medical history
and condition.
 He has the right to view the contents of his medical records,
except psychiatric notes and other incriminatory information
obtained about third parties, with the attending physician
explaining contents thereof.
 The health care institution shall safeguard the
confidentiality of the medical records and to likewise ensure
the integrity and authenticity of the medical records and
shall keep the same within a reasonable time as may be
determined by the Department of Health.
 The health care institution shall issue a medical certificate to
the patient upon request. Any other document that the
patient may require for insurance claims shall also be made
available to him within forty-five (45) days from request.
Right to leave
 The patient has the right to leave hospital or any other health
care institution regardless of his physical condition:
Provided. That
- he/she is informed of the medical consequences of his/her
decision
- he or she releases those involved in his/her care from any
obligation relative to the consequences of his decision;
- His or her decision will not prejudice public health and
safety.
 No patient shall be detained against hi$/her will in any
health care institution on the sole basis of his failure to
fully settle his financial obligations.
 However, he/she shall only be allowed to leave the hospital
provided appropriate arrangements have been made to
settle the unpaid bills: Provided. Further, that unpaid bills of
patients shall be considered as loss income by the hospital
and health care provider/practitioner and shall be deducted
from gross income as income loss only on that particular
year.
Right to refuse participation in medical research
 The patient has the right to be advised if the health care
provider plans to involve him in medical research, including
but not limited to human experimentation which may be
performed only with the written informed consent of the
patient: Provided, That,
- an institutional review board or ethical review board in
accordance with the guidelines set in the Declaration of
Helsinki be established for research involving human
experimentation
- That the Department of Health shall safeguard the
continuing training and education of future health care
provider/practitioner to ensure the development of the health
care delivery in the country: Provided, furthermore
- That the patient involved in the human experimentation shall
be made aware of the provisions of the Declaration of
Helsinki and its respective guidelines.
Right to correspondence and to receive visitors
 The patient has the right to communicate with relatives and
other persons and to receive visitors subject to reasonable
limits prescribed by the rules and regulations of the health
care institution.
Right to express grievances
 The patient has the right to express complaints and
grievances about the care and services received without
fear of discrimination or reprisal and to know about the
disposition of such complaints
Right to be informed of his rights and obligations as a patient
 Every person has the right to be informed of his rights and
obligations as a patient.
 The Department of Health, in coordination with heath care
providers, professional and civic groups, the media, health
insurance corporations, people's organizations, local
government organizations, shall launch and sustain a
nationwide information and education campaign to make
known to people their rights as patients
Patient’s Responsibilities
1. The patient shall ensure that he/she is fully aware of his/her
rights and exercise those rights reasonably.
2. The patient shall provide accurate and complete information
about all matters concerning his/her health.
3. The patient shall report or voice out any changes in his/her
health condition to his/her healthcare provider.
4. The patient shall ensure that he/she understands the
purpose and cost of any proposed treatment or procedure
before deciding to accept it.
5. The patient shall accept all the consequences of the patient's
own informed consent.
6. The patient shall ensure that financial obligations of his/her
health care are fulfilled as promptly as possible, otherwise,
he/she shall make appropriate arrangements to settle unpaid
hospital bills.
7. The patient shall so behave himself or herself so as not to
interfere with the well-being or rights of other patients or
providers of health care.
8. The patient shall first exhaust the grievance mechanism
provided in this Act before filing any administrative or legal
action.
Informed Consent
 Client’s approval (or that of the client’s legal representative)
to have his or her body touched by a specific individual.
 The patient's choice to have a treatment or procedure which
is based on their full understanding of the treatment or
procedure, its benefits, its risks, and any alternatives to the
particular treatment or procedure.
Elements of Informed Consent
 Competence
 Disclosure
 Comprehension
 Voluntariness
 PREVELANCE OF BIOETHICAL ISSUES
Competence
 Refers to patient’s capacity for decision-making.
 A patient is considered competent when:
- One has made a decision
- One has the capacity to justify one’s choice.
- One does not only one’s choice but does so in a reasonable
manner.
Disclosure
 This refers to the content of what a patient is told or informed
about during the consent negotiation.
 The patient must be informed and must understand the
information concerning medical TX to be undertaken so that
the moral decision can be made.
Comprehension
 This refers to whether the information given has been
understood. The disclosure of information is not enough.
 If the patient does not understand what he/she has been
told, then information has not been relayed at all.
 Health care professionals have a professional language and
so they are expected to translate their jargon so that it will be
intelligible to their patients.
Voluntariness
 This means that consent must be voluntary. The patient
must be of his/her own free will to agree to a research or
undergo a medical procedure or intervention.
 He/she must make a choice without being unduly pressured
by anyone else.
Types of consent:
1. Implied consent - agreement is given by cooperating with a
healthcare professional’s instructions for routine procedures.
2. Verbal consent- agreement is given verbally for a treatment
or procedure that doesn’t carry a significant risk.
3. Written consent- agreement is given by signing a document
for a treatment or procedure that is complex or carries a
higher risk.
Exceptions:
Who cannot provide consent?
 Minors
 Unconscious or injured patients
 Mentally-ill patients
2. The person must be legally and medically competent to
delegate the right to consent.
3. The right to consent must be delegated to a legally and
medically competent adult.
Legally Authorized Representative (LAR)
 An individual or judicial body authorized under applicable law
to consent on behalf of another person.
 The LAR may be a parent, grandparent, caregiver who has
the legal authority to grant consent on behalf of another who
has been invited to participate in research.
 An individual or judicial body authorized under applicable law
to consent on behalf of another person.
 The LAR may be a parent, grandparent, caregiver who has
the legal authority to grant consent on behalf of another who
has been invited to participate in research.
Advance Directives
 Written instructions that is recognized under state law and is
related to the provision of such care when the individual is
incapacitated.
1. Living Will - a document prepared by a competent adult that
provides direction regarding medical care in the event the
person becomes unable to make the decisions personally.
2. Durable Power of Attorney (health care proxy) - an
authorization that enables any competent individual to name
someone to exercise decision-making authority, under
specific circumstances, on the individual’s behalf.
3. Advance Care Medical Directive - A document in which an
individual, in consultation with the physician, relatives or
other personal advisers provides precise instructions for the
type of care the client want or does not want in various
clinical scenarios.

Mentally or Emotionally Incompetent Clients

 Unconscious
 Under the influence of chemical agents such as alcohol or
drugs
 Chronic dementia or other mental deficiency that impairs
thought processes and ability to make decisions

Nurses’ Role on Informed Consent

 NOT responsible for explaining the procedure, but for
witnessing the client’s signature on the form.
 The nurse’s signature confirms three things:
1. The client gave the consent voluntarily.
2. The signature is authentic.
3. The client appears competent to give the consent

Proxy consent
 Proxy consent is the process by which people with the legal
right to consent to medical treatment for themselves or for a
minor to delegate that right to another person.
 Three fundamental constraints on this delegation:
1. The person making the delegation must have the right to
consent.